Awhile back, I came across a clear and concise description of Sen. Ron Wyden's health care proposal that is making waves in Washington and indeed across America. It was in the 12/8/07 edition of the National Journal.

Author Marilyn Werber Serafini says, "With this effort, Wyden is emerging as a broker on health care issues in the Senate, a role that has been all but vacant since Sen. John Chafee, R-R.I., died in 1999."

I thought Blue Oregon readers might appreciate this concise description of the plan and highlights from the article. The full article is below the fold.

Under Wyden's proposal, all individuals except those in Medicare and the military would go to a state-based entity, called a Health Help Agency, to enroll in a private health care plan. Every person would have to buy insurance and could be required to show proof when interacting with government agencies, such as applying for a driver's license or enrolling children in school. For those earning up to 400 percent of the federal poverty level, or about $83,000 annually for a family of four, the government would subsidize premiums. Insurance companies would have to offer at least standard benefits, similar to what government employees get, and they could not deny a policy or charge higher prices based on health problems, occupation, gender, genetic information, or age.

During the first two years, employers would have to give employees in wages what the business had been spending on their health care. After that, Wyden predicts, employers would voluntarily continue to pay workers at the higher rate, but they also would be responsible for contributing to employee premiums for private health plans. To deter people from buying excessive health benefits, the current unlimited tax exemption for employer-provided benefits would be replaced with a fixed "health premium" tax deduction. (Although employers would no longer offer insurance under Wyden's original legislation, he is working on a modification, requested by a recent co-sponsor, to allow employers to provide insurance to those workers who want it.)...

...An analysis of Wyden's plan by the Lewin Group, a health care consulting firm, found that, overall, increases in family premium payments would be offset by growth in wages and subsidies, although lower-income people would fare better than middle- and upper-income earners. According to Lewin, families earning up to $40,000 would actually save some money over the course of a year, while health care costs for families earning more than $50,000 would rise by at least several hundred dollars a year. Wyden's plan would cost the federal government about $813 billion in the first year, which would be offset by savings, Lewin found.

And here's the full article:

After another in a string of minor fires hit the Senate office buildings during the summer, a home-state TV station called to check on the whereabouts of Sen. Ron Wyden, D-Ore. His aides didn't know exactly where he was, but they had a pretty good idea of what he was doing. As part of an intensive effort over the past year, Wyden was out pitching his universal health care plan to a fellow senator. And when the fire alarm sounded, he wasn't about to let precious buttonholing time slip away.

Wyden trailed his colleague down the stairs, out an emergency exit, and into a steamy Capitol parking lot. Still talking. Still selling the legislation that key members of both parties are eyeing as a potential starting point for reforming the nation's ailing health care system. "It's one of those instances where a senator could have said, 'Hey, talk to me about that next month; we've got to get out of here,' " Wyden recalled during a recent interview. "But [the colleague] said, 'Let's get outside and talk a bit more.' "

To be sure, even co-sponsors of Wyden's Healthy Americans Act don't agree with everything in the bill. Then again, Wyden doesn't expect them to. He sees the proposal as a starting point for discussion and a way to begin building consensus among a wide range of stakeholders before Washington sets its mind to comprehensive health care reform after the 2008 presidential election. In the polls, after all, voters have consistently ranked health care as their second priority behind Iraq.

Ron Pollack, executive director of the consumer group Families USA, credits Wyden for laying crucial groundwork. "He's put the issue squarely before his colleagues. If the goal is passing this legislation, I'm not sure it's achievable or desirable," Pollack said. But "getting Congress prepared and eager to deal with [health care reform] is very important. It will help the incoming president achieve his or her objectives starting in 2009."

Under Wyden's proposal, all individuals except those in Medicare and the military would go to a state-based entity, called a Health Help Agency, to enroll in a private health care plan. Every person would have to buy insurance and could be required to show proof when interacting with government agencies, such as applying for a driver's license or enrolling children in school. For those earning up to 400 percent of the federal poverty level, or about $83,000 annually for a family of four, the government would subsidize premiums. Insurance companies would have to offer at least standard benefits, similar to what government employees get, and they could not deny a policy or charge higher prices based on health problems, occupation, gender, genetic information, or age.

During the first two years, employers would have to give employees in wages what the business had been spending on their health care. After that, Wyden predicts, employers would voluntarily continue to pay workers at the higher rate, but they also would be responsible for contributing to employee premiums for private health plans. To deter people from buying excessive health benefits, the current unlimited tax exemption for employer-provided benefits would be replaced with a fixed "health premium" tax deduction. (Although employers would no longer offer insurance under Wyden's original legislation, he is working on a modification, requested by a recent co-sponsor, to allow employers to provide insurance to those workers who want it.)

In key ways, Wyden's bill resembles the health care proposals of some leading presidential candidates. Like the Healthy Americans Act, the health care plans backed by Sen. Hillary Rodham Clinton, D-N.Y., and former Sen. John Edwards, D-N.C., would require all individuals to buy insurance and all employers to contribute to the cost. Like the leading Republican proposals, Wyden's bill would remove tax incentives that encourage the purchasing of "Cadillac" insurance plans and would rely on private health plans to deliver insurance.

Since last December, Wyden has met personally with 50 senators about his bill, and he's on a mission to make house calls to all 99. His chief GOP partner is Sen. Robert Bennett of Utah, who serves as counsel to Minority Leader Mitch McConnell, R-Ky. So far, the bill has 11 co-sponsors, including Sens. Charles Grassley, R-Iowa, the Finance Committee ranking member; Debbie Stabenow, D-Mich., chairwoman of the Democratic Steering and Outreach Committee and a Finance Committee member; and Judd Gregg, R-N.H., the Budget Committee ranking member, who also sits on the Health, Education, Labor, and Pensions Committee.

With this effort, Wyden is emerging as a broker on health care issues in the Senate, a role that has been all but vacant since Sen. John Chafee, R-R.I., died in 1999. Chafee created the Senate's mainstream coalition in the early 1990s to bring together dozens of senators to construct a middle-ground alternative to President Clinton's controversial health care reform plan. Former Sen. John Breaux, D-La., another coalition leader, tried to keep the effort going until he left Congress in 2005, but the country's and the Senate's appetite for comprehensive health care reform had diminished and the group faded long before then.

"Senator Chafee was always very helpful to me on health issues, and he was so well thought of," Wyden replied when asked about the comparison. "So if anyone thinks we're trying to model after Senator Chafee, so be it. But there's something we have that is different. The Chafee effort came in response to a pressure cooker in 1993. One of the things that Senator Bennett and I have is that we have the advantage of beginning our efforts outside the pressure cooker."

In developing his plan, Wyden consulted with labor and business leaders. Service Employees International Union President Andy Stern and Safeway Chairman Steve Burd both lauded the effort, while not specifically endorsing the bill. Wyden continues to work with them and other stakeholders. "What I'm trying to do now is reach out to a lot of other groups and individuals who will become very influential in the debate," he said. "Certainly, there are plenty of provisions in here that insurers are going to disagree with strongly, so I'm trying to get their input."

Critics see some serious flaws in Wyden's proposal, even though they may applaud his goals and support certain concepts. Grace-Marie Turner, president of the Galen Institute, a think tank that advocates free-market health care changes, praised Wyden's bipartisanship. "There's real interest in a new approach that organizes the financing of insurance in a different way, and moves toward more portable health insurance that people don't lose when they lose their job," she said.

Still, Turner said she is concerned that Wyden's proposal would be expensive because all health plans would be required to offer comprehensive benefits. "It scares me how prescriptive it is in the insurance that people have to have.... You have to be pretty much the gold standard," she said. "The kinds of creativity that Wal-Mart is offering to lower-wage workers, so they at least get some coverage ... that kind of creativity would be out the window." The burden, she said, "falls on individuals, on payments you have to make, higher taxes you have to pay, and reduced wages in many cases."

Wyden counters that consumers on average wouldn't pay any more for health care. He also notes that people would still be able to get health care through their employer.

But Families USA's Pollack predicts that people will have their doubts about the proposal. "From a political standpoint, I'm not sure people believe that" they wouldn't have to give up the employer insurance that they currently have and like, he said. In addition, Pollack said he worries about Wyden's plan to end Medicaid, which he contends has offered "decent coverage" and "protects against high out-of-pocket costs."

An analysis of Wyden's plan by the Lewin Group, a health care consulting firm, found that, overall, increases in family premium payments would be offset by growth in wages and subsidies, although lower-income people would fare better than middle- and upper-income earners. According to Lewin, families earning up to $40,000 would actually save some money over the course of a year, while health care costs for families earning more than $50,000 would rise by at least several hundred dollars a year. Wyden's plan would cost the federal government about $813 billion in the first year, which would be offset by savings, Lewin found.

Wyden concedes that his drive to round up support and co-sponsors is a "long-range" exercise. "I want this to be something where I hear [senators] out, and they get a chance to see what I'm thinking about," he said. "Senator Bennett and I want to do this in a way that allows the Senate to tackle the premiere issue of our time.... It's an incredibly complicated issue, but I think the fact that we've approached it without saying we have all the answers here is a good starting place."

The latest health letter from Public Citizenmentioned that Wyden's (and Bennett's) health plan was based on the model in the Netherlands. Unfortunately, this article isn't on line at this time. The article had reservations about this plan. Any plan that steers money to insurance companies should be regarded with skepticism.

Last, I get a lot of grief from liberals for liking Wyden's plan, but it's worth taking a look at how far it goes towards integration: [CHART]
There's no private market left. None at all. What you get, instead, is something akin to a single-payer system that contracts with private insurers. All money goes through the government-run insurance pools but is used to purchase private insurance. Unlike Hacker, Wyden doesn't run his pools with global budgets or mandated cost decreases. Rather, the idea is that price sensitivity -- folks will now see all the money they spend on health care, and they can save what they don't need to spend -- will encourage them to purchase HMOs and more cost effective plans, and create competition that brings down costs.

My emphasis there.

The key question for those who support single-payer is this (and please note, I am one of you): How long are you willing to wait?

The choice will come down to this: Universal health care, through something akin to the Wyden/Obama/Clinton plans, passed in 2009 and implemented in 2010... or, another X number of decades while single-payer advocates work to assemble 60 votes in the Senate.

Wyden is on the verge of getting to a filibuster-proof majority for his bill. Once we have a president who takes health care seriously, and is willing to sign a bill, we're there.

I think single-payer would be excellent. But I'm not willing to wait any longer. Just ask Harry Truman how long it might take.

Explain to me what the benefit is of requiring everyone to buy insurance, whether it's affordable and useful or not.

My experience has been that only three insurers were willing to cover my small business AT ALL. One of them was United Health/Pacificare, which apparently has an office policy of denying all claims and only reviewing them again for those squeaky wheels who can get through their customer service phone maze. The other two providers raised their rates exorbitantly each and every year, until my business could no longer afford the coverage for employees at all.

Seems to me, the option to just walk away has been one of the few things giving bargaining power. What's to stop insurers under the Wyden plan from requiring $5,000 mandatory premiums under threat of legal penalties? Will insurers be required to have affordable rates and to honor valid health care claims?

If you read my history of posts to Blue Oregon, you'll see that I generally support Wyden and other Progressive Oregon Democrats, and economic policies that help the little guy. I really want the Wyden plan to prove to make sense and to be good for the thousands of Oregonians who are facing financial hardship due to skyrocketing medical and insurance costs.

This plan gets support from the Rs and the business community for de-linking employment and health coverage. I think it bears consideration. Right now Amer. business is at a competitive disadvantage by having to shoulder health insurance. So this could be a winner, and a road to single payer ..

First off, hats off to Wyden for attempting anything in this mine field.

But, it just seems convoluted.

As a self-employed person, I have had health care that I pay for. When I hired my wife to do office work for me, and at one time had an assistant, we started a group health care plan for all three of us. Well, actually it was two. As my wife was the employee, she carried me as a dependent on her health care coverage in the group plan that I paid for as her employer. Due to a couple reasons, the assistant left about a year ago. That left a health care "group" with one employee and one dependent. We have been paying over $700 a month for coverage.

Now, if I'm required to go buy my insurance as an individual, and my wife too, how much will this cost? We will have to go through all the hassle of this. Then, I will have to pay my wife an insurance bonus of over $700 a month for two years?

Whew! First off, as the business now pays for our health insurance, that is pre-tax dollars. If I turn around and have to pay her the insurance bonus, that is taxed.

-- Actually that will be the same for everyone, and a windfall of tax revenue for Oregon.

But here is my main point - I'd rather pay an insurance tax as an employer of ??? $400 per employee per month, $600 ??, whatever -- And skip the whole middle. I'd rather have national health care without the insurance companies taking a profit cut out of the middle.

Wyden's plan is an okay start - but why should a national health care plan increase my income tax payments and guarantee for-profit health care companies a profit? Why not directly tax me as an employer per employee and cut out the expensive middle man?

Although I think the Wyden plan, or any health care reform plan that gets bipartisan support for that matter, deserves consideration, I am not convinced.

Bill, you said it perfectly - this plan helps out companies that are at a competitive disadvantage because they shoulder health care costs. But at what cost are those companies freed from paying for our health care?

Well, for companies paying minimum wage, at the government's cost, and ultimately our cost. For those who think this is bad, think again - we're already paying for minimum-wage workers' healthcare in the emergency room since most of their employers don't provide healthcare and, well, you can't afford it if you're paid minimum wage. This is an improvement.

For people making lots of money, it comes at their own cost. If they can afford it, especially as costs go down (as they're supposed to under this, or any reform plan), that's great! Let's free companies from the burden of providing healthcare and allow them to pay their employees more and be more competitive. Again, an improvement.

But there's a group in the middle for whom this isn't such a good idea: middle-income workers, who depend on employer-subsidized insurance. Wyden's plan could discourage their employers from covering their healthcare. Unlike their poorer counterparts, middle-income families are lucky enough to not need government subsidies. Unlike their richer counterparts, an increase in healthcare costs isn't easy. Even if healthcare costs drop, will it be enough to make up for the increased amount they pay when their employer stops covering part of it?

This is not to say the Wyden plan wouldn't work. But I think we need to look carefully at any plan that discourages employer contributions and think about how to make those plans affordable for middle class families who already struggle with rising prices and stagnant wages.

Maybe Kari knows this, but I'm pretty sure I read a similar concern about the tax implications of the Wyden plan on a previous post and his bill somehow keeps taxpayers from losing at tax time. Good point to raise.

As for "cutting out the expensive middle man," I couldn't agree more, but I think the chances of this happening are about as high as the chances of passing a Peace Tax through Congress (another idea I love). Single payer legislation has been introduced every Congress since the end of World War II. Not Obama, not Clinton, not even Edwards proposed anything close to single payer. Okay, I get it, politicians. You don't like our idea.

At least Wyden is finding Republican support for some pretty radical insurance restructuring and regulation, which is pretty amazing. What the hell did he promise them to support it?

I'm pretty sure the percentage of employers in the U.S. who provide health coverage is declining every year. Very soon, less than half of all Americans will have health care through their employers. Somebody, do something.

Like the article says and other comments here echo (nice comment, Bill R. !) it's a good starting point and has some serious flaws to it.

Allow me to offer some possible talking points to get the glaring problems better discussed:

1) Mandates that require individuals to carry health insurance are pointless unless there's A) A cap or limit on the costs of providing care, B) Specific parameters for the limits and costs of said insurance premiums, and C) What specific coverage plans would provide what specific services. The obvious parallel here is car insurance. Though we are required by law in Oregon to maintain automobile insurance coverage for all vehicles, there are no limits on what can be done to increase or decrease premiums, nor is there a streamlined system for comparing (in transparent detail) differences between one company's offerings versus another's.

2) Lacking a clause that removes the liabilities of insurance companies that can exclude patients/clients based on the age-old excuse of, "Denial of Coverage Due to Pre-existing Conditions" means that this legislation leaves the door open for health insurance companies to only accept premium patients and leave the uninsured or already ill to either fend for themselves or receive poor-quality/low-coverage options/care. In other words, it looks good on paper and remains the same as what we have currently: A royal Charlie Foxtrot.

3) Should the U.S. Government really be in charge of doling out health insurance? My thinking is no, but it should be in charge of making sure that insurance companies maintain the same, level and ethical standards across the board. The parallels here are the EPA or SEC. Regulations are made and maintained. New ideas are considered and adopted through legislation.

Single-payer has never really struck me as a truly Commercial-American idea. Seems more like a chance for members of the government to make something look great and take credit for it while not really addressing the problem which is people's health insurance companies continue to not cover enough, the costs of care continue to grow and the number of ill, injured or infirmed continue to rise as our population grows and ages.

First, fix the costs. Second, fix the rules. Third, remove the "pre-existing condition" clause as reason to deny coverage. Fourth, make the companies duke it out for customers and may the best plans win. Finally, cover everyone and send the money that would have been spent on creating a new agency to create a national health plan on training new nurses, doctors and medical personnel that will provide the next generation with health care... because there's going to be a lot of patients in a short amount of time.

Single-payer has never really struck me as a truly Commercial-American idea.

The problem with "truly Commercial-American idea(s)" is that they are not all great ideas. Some are absolute disasters. There are two primary problems with having commercial insurance companies involved in health care. One is the horrendous amount of administrative work involved. The other is that with every commercial enterprise there is always the risk of greed directing management. The approving reference to the Securities Exchange Commission above ignores the screw-up and probably malfeasance in the SEC in relation to the current sub-prime problem. The health care system is in enough of a mess without having foxes guarding this coop.

Make sure you read McCanne's comment after the overview of the Lewin Group's analysis where he argues why the entire premise of the Wyden plan is simply out to lunch. No wonder that at last check Wyden has gotten more Republicans to sign on to his idiocy than Democrats.

For those who haven't been paying attention, Chipper here, along with all of the Democrats and most of the Republicans (there's your hint), voted for SB-329 in the 2007 session after the Democratic leadership, in cooperation with Republicans, made sure no single-payer or other public plan was even on the table.

If the Oregon Health Fund Board it created follows the intent of Chipper and his buds, you WILL be required to buy private health insurance in 2009 unless your employer provides it, or you are eligible for a federal or state program, just like with Wyden's plan. Massachusetts enacted a similar plan this year and, surprise, surprise, it is already failing.

My question to Shields is this: Have you been paying attention to what is happening right now with the Oregon Health Fund Board process and the grassroots advocacy efforts to turn that process into something far more progressive and practical than you and the rest of the Oregon Legislature want or Wyden's plan? Why don't you look into that and get back to us?

Patch Adam Perryman writes, "Should the U.S. Government really be in charge of doling out health insurance? My thinking is no, but it should be in charge of making sure that insurance companies maintain the same, level and ethical standards across the board. The parallels here are the EPA or SEC. Regulations are made and maintained. New ideas are considered and adopted through legislation."

I hear that alot. But I think of two things:

First, the government is in charge of my fire protection, and I don't have a problem with it. Not one. If there is a fire, you call 911 and in a matter of seconds fire trucks start showing up, and they do the best they can depending upon the circumstances. It works well, and when I look at my tax bill, I'd call it affordable. Government can run complex programs that benefit people, and run them well. It's just a lot of anti-government Republicant hype that government has to cost more, and run poorly. It's just not true.

Second, should for-profit businesses be in charge of "doling out" my health care? Let's face reality. By having for profit business in charge of health care, we are saying that there is a profit motive to denying my coverage of conditions, types of treatments, and generally delaying health care -- and there is not ANY motivation that I receive good quality health care. This goes beyond insuring that there is not waste or misappropriation in the system, the cost of the claim review process is far greater than what waste and abuse would ever be. What this is all about is "insuring" that I pay the most for the least. In that formula lies greater profit.

What Wyden's plan, Clinton's plan, well, just about every plan does is to provide an insurance monopoly. These companies under the manditory health care systems would be in the driver's seat. I would be REQUIRED to pay for something geared to deny me health care. That is not a health care system, it is a health care denial system.

I prefer Hillary care of Wyden care. Hillarycare is free for most Americans. Wyden's plan doesn't go far enough for total universal care and elderly care.

Steve Johnson has repeated two falsehoods about Clinton's plan (unkowingly I'll presume) that needs to be swatted down for the cyncism and deceit Clinton fully intended in the very formulation of her plan.

The first is what Clinton's plan even is. Under her plan you have the choice of 1) keeping your current insurance (if your employer does if you get your health insurance through your employer), 2) buying into some undefined public plan or 3) BUYING into the Federal Employees Health Benefit Program.

She threw in 2) as a tactical deceit when Kucinich was in the race pushing his single-payer plan (HR-676). She gave no specifics and it has fallen out the dialog now that Kucinich and Edwards are not in the race.

She has tricked people into believing with 3) that most Americans would get "free" health insurance. Nothing could be further than the truth. In fact the FEHBP is a managed competition system of that is in most respects private health insurance. Federal employees have their premiums paid to the private health insurance administrator they choose under this plan by us, the taxpayers. She has not put forth any Medicare-like tax collection system, or any alternate tax system, under this plan to pay the premiums of private citizens who would chose the FEHPB option.

And for those not paying attention, her plan, like Wyden's, and unlike Obama's, would require that you buy what amounts to private health insurance with no real option to buy into any true public insurance plan under penalty of law. Paul Krugman, who before 2000 actually rebuked anyone who dared call him "liberal", has vociferously supported Clinton's concept of mandated participation. He has also supported some from of single-payer, which would mandate participation much like SSI and Medicare does now, and has found himself in a moral bind between that principle and Clinton's hijacking of that principle. Clueless Democrats somehow have taken that as evidence Clinton's plan is "liberal".

Another problem with private insurance companies being involved in health care is that part of the money that goes into the health care financing pot goes as profits to the shareholders of those companies who do nothing about providing health care.

One of the more profound thinkers of the 20th Century was Peter J. Drucker who was regarded as the father of modern management and who was a consultant to many major American corporations. He held a theory that a successful society needed three components: Private enterprises, government, and non-profit organizations. The trick is to decide which functions belong where. France, which was rated No. 1 in the world by the World Health Organization for delivery of health services, chose to make health care a government function. Others that were rated higher on the WHO year 2000 report than No. 37 (the United States) also made health care a government function. The main reason Congress doesn't follow suit for the United States is that politicians in Congress are bought by the health care industries.

Here is at least one problem with Wyden’s plan: Just like when the qualifying age for receiving full benefits from Social Security was raised from 65 to 67 and the contract American workers bought into when they first started working and paying Social Security taxes was broken by the government - people who receive medical benefits as part of their pension will have the retirement contract they worked many years to receive broken by this proposed legislation. People have already paid by way of their employment to receive these contracted medical benefits. Any healthcare legislation that is passed MUST keep those retirement contracts intact. Anything less MUST be rejected!

The key question for those who support single-payer is this (and please note, I am one of you): How long are you willing to wait?

Do we have a choice? Even Mr. Shields's piece describes this as a successor John Chaffee's "middle-ground alternative to President Clinton's controversial health care reform plan." In short, nearly fifty years since Ronald Reagan recorded his diatribe against the evils of socialized medicine and more than a decade after it was obvious to everyone that medical costs were skyrocketing out of control, we're at the point of talking about possibly tinkering with the system a little to sort of potentially give the American people better access to health care. Maybe.

I don't know. It seems like 45 or 50 years since the rest of the civilized world enacted government health care should have been plenty of time. We've waited this long. Another couple of decades and I won't have to worry about it any more.

This is a great conversation, and I appreciate the thoughtfulness that many of the commenters have approached it with.

But there are some substantial misunderstandings going on up here. Patch Adams Perryman, in particular, has a whole lot of very good concerns - that might apply to some other plans (notably Romney's), but have been addressed in Wyden's plan.

Above all, remember that Wyden's plan is a plan for universal private insurance crafted by one of the most progressive members of the Senate, with a decades-long career of fighting for consumers. So, his approach is to empower consumers, not the industry.

OK, to the substance:

First, understand that the market for individual health insurance will shift dramatically. Right now it sucks, because every health insurance company would rather deal with large employers than with individuals. But under Wyden's plan, suddenly there are no employers to talk to - and a 300+ million person individual market.

In that market, everyone in a given region (say, Oregon or Southern California) would pay the same price from a given insurer. (Naismith: Obviously, an insurer that charges $5000/month wouldn't get any customers.)

They are NOT allowed to deny anyone coverage for "pre-existing conditions" nor charge a higher rate to those folks. This is a critical element of Wyden's plan. No more cherry-picking.

The minimum available plan will be a very high-quality plan, at least as good as that which members of Congress. Read that again: The MINIMUM plan will be a gold-standard plan. You can expect a large number of insurance plans to offer that excellent bare-minimum plan, making it easy for consumers to compare them.

In addition, you worry about "a streamlined system for comparing (in transparent detail) differences". Fortunately, Wyden's plan includes a substantial effort in that direction. Each state will have a consumer-driven "health help agency" that will provide exactly that sort of transparency.

Regarding taxation: Wyden's health care plan actually makes your health insurance premiums a tax deduction, though the amount of the deduction would drop on a sliding scale above $150,000/year in income. At $250,000/year in income, no more tax deduction. That, along with the subsidy (100% up to $40,000/year in income and then drops on a sliding scale) is what makes the plan progressive. Low income folks pay less; high income folks pay more.

While an interesting highlight of one Senator's efforts, unfortunately it reads more like a PR piece witten by the Senator's staff than a news piece meant to educate the public. The quotes of critics play a minimal role in the piece and do not really address the fundamental flaw in the Senator's plan. The key flaw is the belief that the same mentality that runs our schools, manages the building and maintenance of our roads will be requiring everyone to have an insurance policy whose minimal coverage is defined by a bureaucrat rather than the market.
Existing mandates regarding drug use therapy, fertility services and others restrict the choices that both employers and employees have regarding the level and cost of health insurance.
The Senator's plan fails to include one of the key elements of health insurance cost control. When employers and employees can exercise discretion about where and when they spend their health care dollar, health care costs drop dramatically. When I pay a discounted retail cost of $40 for a generic drug, I have a much greater incentive to purchase it at Wal-Mart of Target for $4 than when my co-pay is $7. Most people are used to paying $7-$15 RX co pays where it is seen by many as an entitlement.
The author of this article and the editors should immediately have a similar piece that promotes a non-government solution. To not do so is shameful and another milestone in the decline of journalistic standards. I am sure the Heritage Foundation will provide the same sort of documentation to the author that the Senator's office did.

How does the plan address primary care? It seems that if everyone has to have insurance, and it is a fairly high minimum standard, than most Americans would get basic preventive medical services, immunizations, well baby checks, screenings for common diseases and cancers, and the usual array of annual exams/lab tests.

MERELY by providing these (very cheap) preventive services, it sure looks like Wyden's plan could save billions (if not trillions). No one is talking about the massive public health benefit (and cost effectiveness) of providing universal primary care.

The reason why we need a health system to cover EVERYONE is about cost -control, not authoritarianism. Uninsured people drive up the cost of health care.

Of course, any successful government run program (even in a public-private partnership) MUST have a few essentials:
1) electronic medical records and a system of privacy protections to go with it
2) government regulation of capital investments -- and please, let's do a little better than Oregon has done with the certificate of need debacle.
3) evaluation of medical and pharmaceutical technology -- we cannot allow these expensive technologies to drive up the cost of cost or medicine, as they are now

Look at Canada. They have a truly excellent system -- see Health Canada. We don't have to follow their same organizational model for service delivery, but their research and regulatory systems are excellent.

Rose

P.S. Keep a look out for some health care issues closer to home -- Lane County is proposing a $400,000 budget cut to Public Health Services (out of a 1.6 million budget, $400,000 is a 25% reduction). Right now county level Public Health is literally the ONLY medical care system helping many many many vulnerable people (and keeping the chlamydia under control)... maternal child health, immunizations, std clinic (and epidemiological tracking/partner notification services), HIV testing, Hep a & b immunizations and Hep c testing, emergency preparedness, tobacco prevention, and so on...

Above all, remember that Wyden's plan is a plan for universal private insurance crafted by one of the most progressive members of the Senate, with a decades-long career of fighting for consumers. So, his approach is to empower consumers, not the industry.

Sorry Kari, you're flat out peddling propaganda here, but you are just a flak for a lot of Democrats who like to mislead people they are progressive. Ron "I endorse Judge Roberts" and "consumers driven into debt by health care costs should not be able to declare bankruptcy (because he's in the pocket of credit card companies)" Wyden is deceiver #1. Wyden is not progressive.

More to the point, just because you say he wants to empower the consumer doesn't make it so. In fact, when it comes to health insurance, the very idea of empowering the consumer is a pure example Republican antisocial mental illness. The fact is that consumer power in the marketplace is not a meaningful concept when it comes to private health insurance. Private health insurance is by design and market function a vehicle for controlling costs by denying health care. That's the objective with private health insurance because in our health care and health insurance market structure, increased profits only come by reducing payments on health claims for insured patients.

The minimum available plan will be a very high-quality plan, at least as good as that which members of Congress

The cost for plans of this quality will be vastly inflated and by all credible analyses unaffordable, even though people will be forced to spend excessively for it, because private insurance companies will be diverting a portion of what should go to health care into their private, very well-tailored pockets where Wyden lives. Particularly since the health insurance and health care industry will line up on one side against premium-paying consumers on the other.

At the bottom line Wyden's plan is a massive welfare-for-private-insurance-industry fraud because, as Kari actually argues here, it just diverts a large percentage of national treasure to them. The only true progressive and Democratic alternative is a much more cost effective public plan that tells private health insurers to take a hike, and reserves the national treasure we don't give them for other important public needs.

You're just repeating Wyden's Republican talking points here Karl. Fortunately, if you keep it up you'll be making the best arguments against Wyden - and Merkley. Merkley has endorsed Wyden's plan because, after all, what else is a toady like Merkly who is basing his entire campaign on collecting endorsements from sellouts like Wyden gonna do?

I used to think the war would be the thing that would cause the people to clear the liars and crooks out of the Democratic party who have sold out to the Republicans out of office. I now think it is going to be health care. The best thing Oregonians who actually want health care can do this year is vote against Merkley (while getting all over Novick to give us real health care reform), and next time vote against Wyden, the guy who is lining up Merkley and more Republicans than Democrats to rip us off with this plan because it IS a Republican plan. He, like Westlund, another guy who is still a Republican pushing his state-level version in SB-329, just have the nerve to lie about it right to our face because they don't think we're smart enough to know it.

Look at Canada. They have a truly excellent system -- see Health Canada. We don't have to follow their same organizational model for service delivery, but their research and regulatory systems are excellent.

Umm Rose, Canada has much affordable primary care than we'd ever have under Wyden's plan to throw massive welfare to private insurance companies BECAUSE Canada has a PUBLIC health insurance system that most cost effectively provides coverage for primary care.

And what don't you like about their service delivery system? It's primarily based on private doctors who make a reasonable living. We've all but lost private practices here as doctors have been driven by the private insurance system into corporate health care systems, many into specialty practices. Private corporate interests who will line up with the private health insurance companies against people under Wyden's plan, by the way.

Read the PNHP analysis of Wyden's before you starting spouting things you think his plan would accomplish that don't have any solid basis.

Credit to Wyden for trying, but I don't like it. One of the main things driving health care costs are the lobbying efforts of the insurance and drug industries. This doesn't take them out of the equation at all. So part of that $813 billion is the profit expectation of the private firms and their major shareholders. The American people will be compelled to participate. Oversight will be limited due to the private structure.

If we're going to do it, we need to go all the way and demand socialized, single payer health care. Wyden should take this concept and form a pool where companies with a direct stake in American military occupation (oil, defense contracts, gas pipelines) and offensive war efforts are forced to pool their resources to pay for U.S. military involvement. That should return our military budget to the pre-Iraq war level of $300B, saving $200B a year. Then there's the other direct costs that Congress and the President don't even figure into the budget. That's another $100-$200B a year saved. Corresponds quite nicely with the record profits of the oil cartels.

The U.S. Army has been providing single payer health care to the surrounding communities of military bases for years, but we can't do that for our own citizens?

Oh... One more thing. IF we are all going to get taxed one way or another for health care, let's fix the FDA, USDA, and other government bodies that aren't doing their jobs. Make them independent of the executive branch and answerable directly to a bipartisan committee from Congress. Stop feeding aspartame, MSG, high fructose corn syrup and all the other slop to the masses (or at least put Surgeon General's warnings on the packages so people know what they're getting), aggressively limit pollution on industry, limit the work week (even for salaried personnel), and all the other things that are making Americans so unhealthy these days.

Ted and TRS -- I appreciate your passion for single-payer. I share it. But I'm also not willing to wait.

If the choice is between universal health care that's private, and the status quo - what do you choose?

Why not move the ball forward and get everyone covered now, and then shift the fight toward the public/private discussion?

(I'd rather not turn this into another thread about the Senate race, but it's worth noting that both Novick and Merkley have endorsed the Wyden plan. Novick has been a bit more expansive and said he'd endorse "any plan" that gets us to universal. Which is fair enough. If we get to the point where Senator Wyden is in the Oval Office negotiating the details with a President Obama or President Clinton, well, we're a lot further along than we are today.)

"The Rest of the Story" is feeding us some fiction or poorly researched non-fiction.

Wyden voted AGAINST the Bankruptcy "Reform" bill.

As for Roberts, a lot of good Dems voted for Roberts (Feingold, for instance) because they can't just oppose every nominated judge. That one vote hardly tells the whole story on a Senator's progressivism.

Wyden not a progressive? Well, by DC-standards he's a liberal, so you might be right. Give me a break. Anti-war from the very first vote, anti-Patriot Act after the first vote, anti-Bush tax plan, anti-Bush energy plan, pro-choice, pro-consumer, pro-education, pro-tax equity, pro-environment. One of a dozen or so in the Senate who consistently voted for immediate withdrawal from Iraq. Yeah he's made some votes that irritate us - who hasn't? Earl voted for DOMA and Republican takings legislation. DeFazio votes against immigrants and with the NRA. And they are great progressives, just like Wyden.

As for health care, I would have to agree that this is not an entirely progressive plan. Certainly the fact that he got the Republicans to agree to universal care with a massive government subsidy for working and poor people is pretty progressive, as is making insurance companies stop cherry picking healthy people just to make more billions. Allowing the insurance companies to go on living -- not too progressive, but probably the only choice for any leader with a shot at getting a fillibuster-proof bill through the Senate.

I appreciate your passion for single-payer. I share it. But I'm also not willing to wait.

Not sure what you mean by that, Kari. With Wyden's plan you're still waiting for single-payer.

Why should taxpayers be forced to pay money to for-profit corporations? That seems as if it would give the insurance industry even more incentive to entrench their position once something like Wyden's plan been passed, which would turn any "fight toward the public/private discussion" into more of a quagmire than it is now.

Guaranteed income in the form of enforced premiums and tax dollars for low-income offsets? What insurance company isn't going to fight to keep that once it goes into effect? "Please don't throw me into that briar patch, Sen. Wyden!" said Brer Exec.

Unless, of course, the plan has some sort of health care profit regulation. I haven't seen anything of the sort. Without it, you're just going to get something the insurance industry equivalent of Halliburton's conduct in Iraq.

Single payer non-profit is my preference. But there are some good things in the bill (minimum standards of coverage and insurers required to cover anyone). It's probably the best we can do and as Kari said it moves the ball forward.

One thing I would like to see in the bill is a Medicare option. Allow people to purchase coverage from Medicare if they choose. Then we'll see how many people prefer private coverage over government health insurance. The only objection I can see is the private insurers asking "How are we supposed to compete against that?". Who cares?

"Non-Fiction Story" is typical of the deceit offered in support of Wyden. They are clever weasels, you just have to know the facts and where to find them:

Wyden voted AGAINST the Bankruptcy "Reform" bill.

There were two bankruptcy reform acts. Wyden did vote against the "Bankruptcy Abuse Prevention and Consumer Protection Act of 2005" (S-256), passed by the Senate on 10-Mar-2005. But he voted FOR the "Bankruptcy Reform Act of 2001" (S-420), passed by the Senate on 15-Mar-2001, which later become the "Bankruptcy Abuse Prevention and Consumer Protection Act of 2001". The 2001 act had passed both chambers. It was to become law after a final conference on Sept 12, 2001. The rest as they say, is history. Only because of events of the day before did it not become law:

By the way, the sponsor of S-420 that Wyden happily voted FOR in 2001 was Grassley who has also signed on to Wyden's corrupt health insurance plan. Note also that Wyden gladly sold the people out with his vote in early 2001, when the Shrub was still weak, because that's the kind of guy who sells out his constituency (and has a staff who'll sit there and deceive the public for him) that Wyden is.

As for Roberts, a lot of good Dems voted for Roberts (Feingold, for instance)

Just because both Feingold and Wyden voted like idiots for a dirtbag like Roberts, a guy who had less than 2 years total judicial experience before the voted for him to be CJ SCOTUS, is the kind of disreputable argument we've come to expect from Wyden and the kind of people who support him.

Wyden hasn't been out front with a principled stand for years. What appears to be principled, like the telecom immunity issue, is only when he is 100% sure it is totally safe with his constituency for him to do it.

By the way, if you want to know who really owns Wyden and why he is teaming with Republicans to push corporate welfare for the health insurance industry go here:

In 2003-2008, his biggest single contributor is the Finance/Insurance/Real Estate sector, add to that the "Health" sector which includes mainly corporate health care interests, and you get 31% of his total contributions, 33% of his identifiable contributions. The remaining 60%+ spread across 10 other identifiable categories, some of which are catchall categories themselves.

It's pretty clear whose doing the lying and deceiving here. Par for the course for Wyden, his staff, and his supporters.

riverat is congenial enough but misses the point of what Wyden is trying to do here:

One thing I would like to see in the bill is a Medicare option.

Wyden and Clinton are specifically designing their plans to prevent people from having a public insurance option because they know it will be the most cost effective, give we the people control over our health care decisions rather than private insurance companies (notice how Kari pimps Wyden's plan by talking about HMOs where people who have their eye on the bottom line make your health care decisions), and cost a landrush of people and dollars into the public insurance plan which will all but eliminate the private health insurance industry.

And to Kari's fraudulent, propagandistic question: "How long are you willing to wait?" How about no later than the end of this year? Right now the Oregon Health Fund Board is meeting pursuant to SB-329 passed in the 2007 session. Their mandate is to create exactly a state level version of Wyden's plan. They have before them a grassroots plan to do exactly what riverat proposes:

The Democratic and Republican establishment, including Wyden and Kari, are hoping you never know about it, and certainly never actually demand your legislators give it to us because they, like Kari, want to make sure you are forced to by private health insurance.

The only way Wyden is going to get to a veto-proof majority is get Republicans on board because Democrats know that Wyden is headed in exactly the wrong direction. His plan is contrary to everything Democrats who are actually concerned about health care for working people stand for and know we need to do. In fact, Sanders and Feingold are sponsoring bills that represent the Democratic position: Offering enormous opportunity and support for states to create exactly what grassroots advocates are pushing for here in Oregon avoid the corrupt influences of the private health insurance industry that Wyden represents so we can get to national plan state-by-state like Canada did.

Rest of the Story, you might want to go back to Portland IndyMedia, where you belong. I looked at the link you provided and among the 36 Democrats in the Senate who voted for the 2001 bankruptcy bill were those well-known neo-con "weasels" Patrick Leahy, John Edwards, and Patty Murray. Whenever people around this board talk about bankruptcy reform, they are referring to the bill that became law in 2005, not one from the dustbin of history that did not pass. Who is the deceiver, hmmmm?

Oh, and way to insult the two-thirds of the state who consider themselves Wyden supporters. His supporters are all "liars and deceivers? Charming.

The Democratic and Republican establishment, including Wyden and Kari, are hoping you never know about it, and certainly never actually demand your legislators give it to us because they, like Kari, want to make sure you are forced to by private health insurance.

TRS -- I actually don't know much about SB 329, other than the barest of outlines. Why don't you write a guest column and tell BlueOregon's readers all about it? That'd be more productive than imagining what it is I want to "force" consumers to do.

Hey Non-Fiction Story - Some support Wyden because they don't know the facts, others because they don't care, relatively few advocate for his positions. So they are in a completely different category than you and him. You keep pulling the tactic of throwing red herring arguments like this, so it's pretty clear either you don't have the grey matter to understand the difference, or the personal integrity to care.

Everyone should note also how you don't speak to the facts when you just point out how other Democrats --- the same ones who rolled over for the last 7 years and brought our country low --- have done it too. Didn't your momma teach you it doesn't matter what the other kids do, you are responsible for what you do? All you succeed in doing by pointing out other Democrats who voted for a bill whose provisions you probably don't even know, are how they are just more examples of failure to take responsibility for the damage they've done to the country. And why all of the NW Democrats you cite should be voted out of office for better Democrats.

Wyden voted for bankruptcy reform and there would not have been a 2005 vote if the utterly improbable events of Sept 11 had not intervened. He cast many other votes, including the vote for Roberts, which show his vast problems with his principles. And that has nothing to do with the people who voted for him, it just says we have failed to encourage better people than Wyden to come forward.

Kari, appreciate the invitation but the discussion will have much more import if you invite Shields, one of the guys who will actually have to vote on this to do the research and a provide a thorough explanation. We and he will learn a lot more, and when one of their own goes on record legislators are put in the spotlight where we can see much more clearly what they are and aren't doing.

Chip, you might want to consider volunteering here to continue what you started with a fair presentation of what SB-329 is and isn't, as well as the details of the cited grassroots advocacy. No need to get into the battles around SB-27 and SB-329, although I suspect most would find the Democratic leadership infighting over those measures enlightening for how it changes the popular picture of who is and who isn't the average working person's friend in this health insurance battle. You represent District 43, from the things I've read there are definitely people from District 42, and quite possibly from your own District 43 who support it.

While ranked 37th in world, the US spent ~$7,600 per person on health care costs, over $2 trillion in ’07. Three times the per person costs of the top rated countries.
The insurance companies, big pharma and hospitals (Hey there, Bill Frist) call it “health care” as moral cover.
Inching towards “universal” health care is the same as the inching towards impeachment: do you really think you’re going to get either one.
This is just another case of domestic profiteering. Any plan that doesn’t eliminate the for-profit companies is just lipstick on a pig.
A thousand words have been wasted above analyzing the lipstick.

I found it, and while darrelplant/The Rest of the Story's blog is pretty thoughtful, it's also pretty boring. Perhaps dp/trs should post on his or this blog about why single payer is preferable and achievable. Be sure to throw in lots of "fraudulent" "propogandistic" "weasels" kind of language and insult great progressives like Chip Shields and Ron Wyden.

Don't have a blog and I'm not darrelplant. But if that makes some of your day to believe it, like you want to believe Wyden actually wants to give us a good health care plan, go right ahead. You'll probably like this other vote of Ron's too: He voted FOR the Medicare Prescription Drug, Improvement, and Moderniztion Act of 2003 (HR-1). That's the one that gave us Medicare Part D and PROHIBITED the U.S. government from negotiating for the best prices.

The argument there was all about pushing people into the private insurance marketplace and somehow competition there is going to fix the system, same as Wyden is peddling with his health insurance plan. We know the aftermath. Drug prices continue to the highest in the world by a wide margin and people are faced every year with guessing if the plan they currently have will cover the medications for the medical problems they will develop OVER THE REST OF THE YEAR.

But that isn't even the whole story. On Nov. 24, 2003, there was two critical votes in the Senate that could have kept the debate alive and maybe even scuttled the whole thing. The first was to invoke cloture. Cloture being the tactic Democrats whine that the Republicans are now using to thwart the majority will, Wyden voted YEA with the Republicans and AGAINST 26 Democrats and 3 Republicans (Chafee, Hagel, McCain - interesting, huh?). The second vote later in the day was another maneuver that would have blocked passage. In that case, Wyden again voted YEA with the Republicans and AGAINST 34 Democrats and 2 Republicans (Hagel, McCain).

The other big story in this episode was how Rep. Billy Tauzin, the person widely credited with writing this bill BECAUSE it would keep drug prices high and that Wyden voted with, quit Congress the next year and took a job as a lobbyist with the pharmaceutical industry. Yea, Wyden is all about putting the people ahead of the drug and health insurance industry.

It is not single-payer. I am not in love with the phrase, and I do not demand that all problems be solved by government run programs, but it abundantly clear that the major problem with our healthcare delivery system is the insurance companies - whether independent entities like Blue Cross/Blue shield or combined insurance and delivery entities like Kaiser Permanente. It is true that reform is difficult when these politically powerful businesses are in opposition, but it simply not feasible to fix a problem when the major source of the problem has veto power over remedies to the problem. Some argue that Wyden's plan can be a step toward single-payer. I see it as a step toward discrediting government involvement in healthcare, because the plan will fail to control costs.

I also dislike Wyden's plan for the same reasons I am a Democrat. I can tolerate government requiring the payment of taxes in order to fund programs that benefit the general welfare, as long as the needs are real and the money is used wisely. I am not comfortable with government telling me what I cannot do, and less comfortable with government telling me what I MUST do. Such coercion should be reserved for situations that are clearcut social needs, e.g., I must remove attractive nuisances that might injure children going about their normal lives, or I must keep my motor vehicle in a condition that allows for safe use. Telling me that I must buy health insurance, and that there will be programs available to subsidize my costs if my income is deemed insufficient is the kind of government intrusion that drives me and lots of other people crazy, and turns many folks into libertarians and anti-government Republicans.

Making the health insurance companies go away will not be easy, especially when our political system allows campaign contributions to be used as business investments, but it seems to me to be the only way out of this mess that is killing and maiming thousands every year and driving us all broke.

My compliments to the real health-care progressives who have posted on this thread: Tom C., darrelplant, The Rest of the Story, bye bye Smith, Ted, William Bodden, et al.

The rest of you need first of all to understand that this is an issue of democracy; large majorities have been clamoring for single payer, universal health care for decades, and regressives have been saying for just as long that it is "politically unfeasible", i.e., the corporations who pay politicians like Wyden don't want it.

Let's also consider the fact that positions on health care can't be disassociated from other issues, like fair trade, bloated and irresponsible military budgets, impeachment of the worst criminals in our history, etc. It's time to jettison all regressives, Democrat or Republican. We centrist/progressives are a majority, and we will not continue to support lesser evils forever.

It's great news for the private insurance companies, which get lots of new customers, but it screws employees who now get good coverage because of their bargaining power with their employers or their employer's good values. It also screws the employer who provide coverage by taxing them to pay for subsidies to those buying private insurance. And it doesn't really save much money on a percentage basis.

The key question for those who support single-payer is this (and please note, I am one of you): How long are you willing to wait?

This is a fair point, but on the opposite side we should note that if we settle for a quick fix that is defective we will almost certainly be stuck with it for the rest of our lives and very unlikely never get the optimum single-payer system. As Michael Moore noted in "Sicko" the French government is greatly concerned with the opinion of its citizens whose health care system was rated No. 1 in 2000 by the WHO while the American people defer to the American government; that is, the corporatocracy that really is in charge.

How much have Wyden and Bennett received in campaign contributions from Big Pharma and other corporations running our health care system? Has Billy Tauzin let them know he might be interested in hiring them as assistants if they decide to retire from the Senate?

Yeah, darrelplant, keep on trying to be aloofly cute with middle-age language and anonymous indignation.

I didn't realize that blogging under my own name (albeit with no space and all lower case) was now considered "anonymous." I've used the same online name for years at a variety of blogs. I've never used another name. I mean, who has time? You're seriously deluded on that point.

As for "middle-age language", well, I am middle-aged, so I suppose you've got me there.

Senator Wyden's plan is solid, bold and quite frankly, visionary.

No, it's not.

Your suggestion that BlueOregon represses speech is best left for your own paranoid rantings elsewhere.

You don't know Jack if that's what you think I said. Someone calling themselves "Non-Fiction Story" was the one who told my supposed doppleganger to "go back to Portland IndyMedia." That sure sounds familiar. I never said Kari or anyone else officially representing Blue Oregon was preventing the discussion at all, in fact I know he's not because I'm still posting here (and only under my own name). But the eliminationist attitude of some of the commenters seems a bit bizarre.

Just for kicks, perhaps you amateur kerning sleuths can figure out how I supposedly managed to post as "The Rest of the Story" at 8am while I was in the air on the first leg of a trip to Philadelphia.

Be sure to throw in lots of "fraudulent" "propogandistic" "weasels" kind of language...

<h2>Oddly enough, according to Google, none of those words appear in any of the nearly 1,000 posts at darrelplant.com over the past four-and-a-half years. But I'll add them to my vocabulary if it will increase the readership. Mostly, new people come for the parody TIME covers, but I did those almost three years ago.</h2>

To Republicans in Congress and in state capitals across the country: It's time to refuse the NRA's support and their money. And donations received in the past should be donated to organizations supporting the survivors of gun violence.